Clinical case studies and product evaluations: How VITABLOCS are used around the world

Initial situation
Due to trauma, teeth 11 and 21 had been restored with composite build-ups, which were now several years old. The patient was dissatisfied with the esthetics of both teeth, as she did not like their shade or shape. This is why she had wanted a new restoration for some time.

Solution
After analyzing the anterior teeth and the esthetic zone, we suggested that the patient not only have teeth 11 and 21 restoratively replaced, but also teeth 12 and 22, which were slightly tilted palatally, in order to achieve a better overall esthetic result. The treatment was planned and carried out using a mock-up. The decision was made in favor of four veneers made of the highly esthetic and polychrome fine-structure feldspar ceramic VITABLOCS TriLuxe forte 1M2.

Why VITABLOCS TriLuxe forte?
We used VITABLOCS TriLuxe forte because a natural chroma gradient, as well as luminous and fluorescent effects, are already integrated into the blanks. In the CAD design, the veneers could be morphologically designed as planned in the analog wax-up. The macrotexture was also taken into account, so that after the restorations had been milled from fine-structure feldspar ceramic, only small details of the microtexture had to be worked in. After the final finishing, all that was left to do was minimal characterization and glazing. With VITABLOCS TriLuxe forte, the most highly esthetic restorations can be created with minimal effort.

Initial situation
A 72-year-old woman came to the practice because she was not satisfied with the esthetic appearance of her teeth. The clinical inspection revealed severely abraded and erosively damaged anterior teeth with exposed root areas.

Solution
Guided gingivectomies to harmonize the gingival collar and controlled veneer preparation in the anterior area are to be performed using a wax-up. The intraoral mock-up and the preparations were each scanned; using this information, 12 veneers were constructed from the polychrome feldspar ceramic VITABLOCS TriLuxe forte in the shade 1M2. Thanks to the light dynamics and the integrated shade gradient, only minimal characterization was required after the restorations had been finished to achieve a highly esthetic result.

Why VITABLOCS TriLuxe forte?
We used VITABLOCS TriLuxe forte because the patient wanted fast CAD/CAM restorations that offer a natural play of shade and light. The polychrome VITABLOCS variant features an integrated, finely nuanced shade gradient and can be quickly and precisely processed, thanks to its finely structured ceramic. In the design software, the restoration can be placed in the virtual blank in such a way that the chroma gradient can be controlled individually for each patient.

Initial situation
Following root canal treatment, a 20-year-old patient was unhappy with the dark discoloration of tooth 11 that was otherwise symptom-free. X-rays showed sufficient root canal filling.

Solution
After an in-depth consultation, the patient chose a fast, all-ceramic crown restoration made of the polychromatic feldspar ceramic VITABLOCS TriLuxe forte to meet esthetic expectations, and stabilize tooth 11 for the long term. The original morphology was to be retained, which is why it was scanned prior to preparation for designing the crown. Precise determination of the shade of the adjacent tooth was carried out using VITA Easyshade V in order to be able to select the appropriate block.

Why VITABLOCS TriLuxe forte?
We used VITABLOCS TriLuxe forte because the patient wanted a permanent, highly esthetic crown restoration in the esthetic zone in just a single session. Thanks to the integrated shade gradient and the brilliant play of shade and light of the polychromatic feldspar ceramic blank, we were able to achieve the desired result with minimal characterization, despite the limited timeframe.

Initial situation
A 67-year-old patient was unhappy with the position and discoloration of non-vital tooth 11. Due to the extreme rotation, the patient was advised to have orthodontic treatment prior to restorative measures. However, despite the more invasive preparation, she ruled out this proposal and requested an immediate, fast and inexpensive esthetic restoration.

Solution
A full crown restoration was to be fabricated from the polychromatic feldspar ceramic VITABLOCS RealLife using CAD/CAM technology. The blank features a curved, three-dimensional layer structure between the dentine and incisal area. When positioned accordingly during nesting, this facilitates a shade gradient appropriate to the patient. The basic tooth shade 3M2 was precisely determined using the VITA Easyshade V spectrophotometer, and in block mode, the most appropriate blank was suggested for the digital workflow. Prior to preparation, root canal treatment of tooth 11 was successfully completed.

Why VITABLOCS RealLife?
We used VITABLOCS RealLife feldspar ceramic because with precise tooth shade determination, we were able to select a block that offered shade accuracy. Thanks to the coordinated virtual positioning of the restoration in the three-dimensional layer structure of VITABLOCS RealLife, it was already possible to reproduce the shade gradient of the adjacent incisors. As a result, the VITA AKZENT Plus stains were only used to characterize the final nuances.

Initial situation
Our patient was unhappy with the shade and shape of his upper anterior teeth. Tooth 22 in particular appeared strongly discolored following root canal treatment and had been restored with an inadequate composite filling. Photo documentation and digital smile design clearly showed: The narrow dental arch of the anterior teeth with its palatal tilt did not harmonize with the buccal corridor. The positioning of the tooth axes was irregular.

Solution
As part of digital smile design, all esthetic parameters were optimized virtually, and an intraoral mock-up created on this basis. Following a final discussion with the patient, guided mock-up preparation was carried out (tooth 13 to 23) so that treatment would be as minimally invasive as possible and would not extend beyond the enamel to ensure optimal adhesive bonding. The tooth axes were also corrected during preparation. This was followed by CAD/CAM fabrication of five veneers and one crown on tooth 22. VITABLOCS TriLuxe forte was selected in bleach shade 0M1 in order to meet the patient's wish for teeth that were as bright as possible.

Why VITABLOCS TriLuxe forte?
We chose the polychromatic, bleach-colored VITABLOCS TriLuxe forte 0M1 so we could meet the patient's demanding esthetic requirements. Thanks to monolithic fabrication as part of the digital workflow, minimally-invasive removal of substance during preparation was still possible despite correcting the tooth axes.

Initial situation
A patient who was not a full-time resident in Chile presented in our dental practice because the esthetic appearance of his lower front teeth bothered him. An incisor (tooth 32) had been lost, which had caused tooth 31 and 33 to tilt and rotate. The advanced recession of tooth 31 and localized periodontitis were particularly noticeable. The patient did not want orthodontic treatment. He insisted on fast restorative treatment.

Solution
Following professional teeth cleaning, a three-dimensional X-ray image (DICOM) was taken, and virtual models (STL) of the teeth separately and in occlusion were generated by scanning intraorally. Both datasets were matched so that the bone level and tooth soft tissue could be taken into consideration in CEREC Smile Design and in the resulting model design. Based on this virtual planning, the aim was to even out the lower anterior jaw in one session by restoring tooth 42 and 41 with veneers, and tooth 33 and 31 with crowns made from VITABLOCS TriLuxe forte.

Why VITABLOCS TriLuxe forte?
The feldspar ceramic VITABLOCS TriLuxe forte was the ideal choice for a CAD-CAM material in this case because it offers a highly precise shade match and translucence. The VITA AKZENT Plus stain and glaze system provided an individual touch to suit the patient. Once they had been created in the practice laboratory, it was possible to seat the four restorations adhesively in just a single session.

Initial situation
A young patient presented with moderate tetracycline discoloration and exposed cervical areas, as well as abrasion to the incisal edges of the upper middle incisors. Following clinical and X-ray diagnostics, all teeth proved vital and asymptomatic, with a normal periodontium. The patient asked for a bright reconstruction of the visible tooth area.

Solution
Following preparation, the patient was fitted with 16 minimally-invasive veneers made of bleach-colored VITABLOCS MARK II material with a layer thickness of 0.8 to 0.9 mm. and no functional contacts.

Why VITABLOCS Mark II?
VITABLOCS offer lifelike shade effects, while also masking discolorations. The shade range is varied and enables selection of the appropriate block. The surface texture is similar to that of natural enamel. With VITABLOCS, dentists and dental technicians can predictably meet the different needs of patients.

Initial situation
A patient with pronounced malocclusion presented with irregular incisal edge and gingival margin contours. The middle upper incisors were fractured and discolored.

Solution
The crossbite was first treated with Invisalign. Following a mock-up simulation, a minimally-invasive laser gingivectomy was performed to harmonize the gingival margin, and preparation was carried out. The patient's esthetic zone was then restored in a single chairside session with veneers made of VITABLOCS Mark II.

Why VITABLOCS Mark II?
Because of the precise margins after milling and the natural translucency of the final restorations.

Initial situation
A young patient, 25-years-old, was unhappy about a defective older filling in upper molar 27.

Solution
The older filling was removed, secondary caries excavated, endodontic revision carried out and the tooth restored with an all-ceramic overlay made of VITABLOCS Mark II.

Why VITABLOCS Mark II?
We chose VITABLOCS Mark II because the abrasion (similar to enamel) harmonized with the natural antagonist, with regard to function, from a long-term clinical perspective.

Initial situation
A young patient in her 20s with post-traumatic discoloration of the right upper middle incisor.

Solution
In order to achieve perfect esthetics, the desired shade of the adjacent, healthy and central tooth, as well as the discoloration of the prepared tooth surface, were taken into consideration when selecting the block. After the minimally-invasive preparation was scanned, a monolithic veneer was constructed using VITABLOCS Mark II 0M1 and milled.

Why VITABLOCS Mark II?
Due to the integrated natural esthetics, as well as the translucency and fluorescence of VITABLOCS feldspar ceramics that are similar to natural dentition, we achieve the best monolithic results using a digital workflow. In this case we needed to compensate the dark shade of the prepared tooth with 0M1 and chose VITABLOCS Mark II because this shade was not yet available for VITABLOCS TriLuxe forte at that time.

Initial situation
Following orthodontic treatment, a young patient presented with discoloration, cracks and inadequate conservative restorations in the esthetic zone. The middle incisors seemed to be too short.

Solution
The patient was treated with 10 minimally-invasive veneers made of VITABLOCS MARK II. The restorations were planned using an idealized wax-up, which was placed in the patient's mouth as a mock-up and verified. This made fabrication of the final restorations predictable and simple.

Why VITABLOCS Mark II?
VITABLOCS allowed for minimally-invasive treatment in the enamel area as part of the digital workflow.

Initial situation
A young patient presented with discolored, non-vital upper incisors with insufficient composite fillings.

Solution
First, endodontic treatment was carried out on tooth 11, 12, 21 and 22. These were also stabilized with fiberglass posts and composite abutments. The natural teeth were then lightened by bleaching. Following wax-up and corresponding mock-up preparation, the tooth stumps were scanned intraorally, and temporary VITA CAD-Temp crowns fabricated using CAD/CAM technology to simulate the shape and function of the planned ceramic restorations. After successful try-in, the permanent ceramic crowns were fabricated monolithically from the VITABLOCS Mark II feldspar ceramic using a digital workflow.

Why VITABLOCS Mark II?
VITABLOCS Mark II offers both pronounced brightness and also good coverage, which is essential when working with non-vital and discolored teeth. Thanks to the optical properties, the tooth can be reconstructed with a natural appearance.

Initial situation
A patient presented with composite restorations of tooth 11 and tooth 21 that, after six years, had become severely abraded and had faded as a result of daily cleaning. For this reason, the incisors were to be reconstructed using all-ceramics, with lasting prevention of further loss of incisal substance.

Solution
To begin with, an intraoral mock-up was fabricated using composite to simulate the planned final result with the patient. The mock-up was worn as part of a try-in for two days. The patient was satisfied with the shape and function. As a result, both teeth could be prepared using the mock-up and scanned intraorally, and final crowns fabricated monolithically using VITABLOCS TriLuxe forte and seated adhesively.

Why VITABLOCS TriLuxe Forte?
The polychromatic feldspar ceramic VITABLOCS TriLuxe forte was selected as the restoration material. Thanks to the integrated shade gradient, highly esthetic monolithic restorations could be created that harmonized with the natural hard tooth substance. The VITABLOCS feldspar ceramic guaranteed long-term stability and abrasion properties similar to enamel. The restorations have been in the patient’s mouth for six years. Abrasion is stable and there have not been any complications.